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Pre Existing Condition Insurance Plans (PCIP)

Pre-Existing Condition Insurance Plans

Preexisting condition insurance plans were set up in 2010 as part of the new healthcare legislation. These plans were specifically created for people who have preexisting conditions and have either 1) been without health insurance for six months or more, and/or 2) were denied health care coverage based on their condition. These plans ensure that people who otherwise would have been uninsurable now have an option for the insurance they most certainly need. These plans cover major medical expenses including doctor visits and prescriptions plans just like any health plan would and similarly come with the same costs for copayments, deductibles, and prescriptions depending on the plan you choose.

Eligibility for PCIP Plans

The preexisting condition health insurance plans have certain qualifications that you must meet in order to sign up. The federal government sets these qualifications. In addition, if PCIP is run in your state there may be specific requirements for your state plan.

In order to be eligible for a PCIP, you have to:

  • Live legally in the United States or be a US citizen
  • Not had health insurance for 6 months again
  • Have a preexisting condition

Additionally, you will not be eligible for PCIP plans if:

  • You have health insurance, even if it doesn't cover your condition
  • You are part of a state run high risk pool
  • You are enrolled in Medicare, CHIP, VA,TRICARE, or Medicaid
  • You have coverage from your job or from COBRA
  • You are enrolled in a limited benefit health plan

Cost of PCIP Coverage

For federal PCIP plans, there are three different options for the types of plans you can sign up for. The first is a standard plan, the second is an extended plan, and the third is a HSA (Health Saving Account) plan. Each plan will have it's own premium costs, deductibles, and copayments.

With each federal plan, once you have covered the deductible set forth in the plan, you will be responsible for 20% of the in network medical expenses. Normally the maximum out of pocket expense is $7,000 and this could be less if every service you use is in your network. Additionally there is no lifetime or yearly cap on services. You can find the average monthly premiums below.

How to Apply for PCIP Insurance

There are multiple ways to apply for PCIP insurance depending on where you live. If you live in a state with federal PCIP plans, then you can apply using any of the following methods.

  • Option 1: Apply online through http://www.pcip.gov and complete the online application. You will also have to mail in the documents required in the application which include one of the following: A denial letter from an insurance company for individual insurance coverage or an offer of individual insurance coverage (not health insurance offered through a job) dated within the past 12 months that you didn't accept because it didn't cover your medical condition.
  • Option 2: Apply by mail using the application from http://www.pcip.gov and mailing it into the address on the form with the appropriate paperwork.
  • Option 3: Apply by phone by calling 1-866-717-5826

Please note: If you live in a state with its own PCIP insurance plan then you must follow the state instructions.

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